The applicant wishes to continue his development as a clinician investigator in Geriatric Medicine with the following long-term objective: to perform studies that will lead to a better understanding of herpes zoster and postherpetic neuralgia and their optimal management. Herpes zoster and postherpetic neuralgia (PHN) are common and potentially disabling conditions in the elderly but their mechanism of development and their optimal treatment is unknown. Prior work on the development of zoster has focused primarily on aging and diminished cellular immunity, but other as yet unknown factors are important in zoster. The conditions that lead to PHN have not been systematically investigated. The applicant's research aim is to identify factors that lead to zoster and PHN using clinical and biochemical epidemiologic methods. In order to identify risk factors for zoster and postherpetic neuralgia in community dwelling elders, the applicant will examine the effects of race, site of residence and psychological stress on zoster and PHN in a stratified sample of racially mixed persons, age range 65- 104, from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE). This population will allow for a prospective, cohort study. The variables mentioned are chosen because of the results of our prior studies and preliminary EPESE data. Also, in order to better understand zoster and PHN, the applicant will examine the humoral immune response to varicella-zoster virus (VZV) in different populations of elderly persons from within the EPESE. IgG and IgM antibodies to VZV will be measured in EPESE subjects with recent and remote zoster, PHN and latent VZV infection by enzyme-linked immunosorbent assay and immunoblot techniques. This information will provide evidence for or against our current theoretical models of zoster and PHN and it will allow for the examination of the effects of subject variables such as stress and race on the immune response to VZV. These studies will further our understanding of the development of these diseases, may lead towards prevention or modification of zoster of PHN, and may eventually lead to better therapies for these conditions. The applicant will have ample opportunity to care for elderly patients as medical director of the Geriatric Evaluation and Treatment Clinic at Duke University Medical Center and as an attending physician on the inpatient geriatric medicine service at the Durham VAMC. These positions will give him multiple opportunities to teach fellows, housestaff and students the principles of Geriatric Medicine, which in turn will allow him to serve as a role model for future geriatric clinician investigators.